中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (48): 8963-8967.doi: 10.3969/j.issn.2095-4344.2012.48.007

• 人工假体 artificial prosthesis • 上一篇    下一篇

应用低分子肝素对初次全髋及全膝关节置换后失血的影响

许 杰，马若凡，李亮平，蔡志清，董文武   

  1. 中山大学附属孙逸仙纪念医院骨科，广东省广州市 510120
  • 收稿日期:2012-04-12 修回日期:2012-05-18 出版日期:2012-11-25 发布日期:2012-11-25
  • 作者简介:许杰☆，男，1975年生，广东省广州市人，汉族，2008年中山大学毕业，博士，副教授，副主任医师，主要从事关节外科的临床及相关研究。 lplllpfe@163.com

Effect of low molecular weight heparin on blood loss after primary total hip arthroplasty and total knee arthroplasty

Xu Jie, Ma Ruo-fan, Li Liang-ping, Cai Zhi-qing, Dong Wen-wu   

  1. Department of Orthopedics, Sun Yat-sen Memoral Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China
  • Received:2012-04-12 Revised:2012-05-18 Online:2012-11-25 Published:2012-11-25
  • About author:Xu Jie☆，Doctor, Associate professor, Associate chief physician, Department of Orthopedics, Sun Yat-sen Memoral Hospital, Sun Yat-sen University, Guangzhou 510120, Guangdong Province, China lplllpfe@163.com

PDF

654

被引次数

20

摘要：

背景：下肢深静脉栓塞为人工髋、膝关节后常见并发症，置换后应用低分子肝素抗凝已成为常规指导原则。
目的：探讨应用低分子肝素对初次全髋关节及全膝关节置换后失血的影响。
方法：回顾分析 2006年1月至2011年6月初次行人工关节置换病例529例，对有否应用低分子肝素抗凝者分为应用组和对照组。置换后8-12 h开始，应用组每天皮下注射低分子肝素4 000-6 000 U，连续使用10-15 d；对照组未使用任何抗凝药物。统计比较病例失血总量、显性失血量及隐性失血量。
结果与结论：应用组中关节置换患者出血总量与对照组比较，差异有显著性意义(t=-23.42，P < 0.01)。膝关节置换患者以显性失血为主，髋关节置换患者则隐性失血量较大，二者比较，差异有显著性意义(t=-23.3，P < 0.01)。说明人工关节置换后使用低分子肝素抗凝治疗，可增加置换后失血量，这其中髋关节置换及膝关节置换显性、隐性失血比例各有不同。单纯通过计量置换中出血及置换后引流来评估有效血容量的丢失较为片面。抗凝治疗的同时应密切关注血红蛋白变化，结合手术特点充分考虑隐性失血，及时补充血容量。

关键词: 髋关节, 膝关节, 低分子肝素, 关节成形, 出血

Abstract:

BACKGROUND: Deep vein thrombosis of lower limb is a common complication after total hip arthroplasty and total knee arthroplasty, and the application of low molecular weight heparin has become the general guiding principles after arthroplasty.
OBJECTIVE: To explore the clinical impact of low molecular weight heparin on blood loss after total knee arthroplasty and total hip arthroplasty.
METHODS: Between January 2006 and June 2011, the clinical data from 529 patients undergoing primary total knee arthroplasty and total hip arthroplasty were retrospectively analyzed. In accordance with using low molecular weight heparin or not, the cases were divided into two groups, the trial group and the control group. In the trial group, the patients received subcutaneous injection of low molecular weight heparin (4 000-6 000 U/day) from 8-12 hours after arthroplasty and lasted for 10-15 days. In the control group, the patients received no anticoagulation drug. The total blood loss, dominant blood loss and hidden blood loss of two groups were compared.
RESULTS AND CONCLUSION: There was significant difference of total blood loss between two groups (t =-23.42, P < 0.01). The dominant blood loss was the major part of blood loss for the total knee arthroplasty cases and the hidden blood loss was the major part of blood loss for the total hip arthroplasty cases, there was significant difference of dominant blood loss and hidden blood loss between two groups (t=-23.3, P < 0.01). Application of low molecular weight heparin after arthroplasty can increase the patients’ bleeding volume; the percentage of dominant and hidden blood loss in total hip arthroplasty is different from that in total knee arthroplasty. Calculation of the dominant blood loss, including operating bleeding and postoperative draining was not enough to estimate perioperative blood loss. We should pay more attention on the changes of hemoglobin during anticoagulant therapy. Fully consider the hidden blood loss according to the surgery characteristics and thus result in better preparation of blood during operation.

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